I am 30-year-old unmarried woman. I have been feeling an acute pain on the right part of my abdomen since few days. Diagnosed with mild fatty infiltration in liver I often feel pukish (it’s severe when I am with people and I have also started intolerance with smell). Sleep is disturbed lately. Will such infiltration in liver have a lifelong impact? 

The liver is situated on the right side of your upper abdomen but you have not mentioned whether the pain is in upper or lower abdomen. If it is the right upper abdomen then one must rule out pleuritis — the inflammation of the outer layer covering of your lower lungs.

The feeling of nausea could be a manifestation of your gastrointestinal system or a gallbladder calculi/stone. The sleep and smell factors could be more of some sort of psychological contributing factors.

Having a mild fatty liver by your age is not an uncommon finding in an abdominal ultrasound. Any changes in your menstrual by your age in an unmarried state would have to be looked into. Certain investigations like routine stool and urine test, blood test especially covering liver and kidney, chest X-Ray, abdominal ultrasound, endoscopy, colonoscopy and an abdominal CT scan would have to be contemplated under the guidance of a gastroenterologist and possibly a gynaecologist.

Some common causes of pain in the right upper quadrant abdomen would be:

Gall bladder: Gallstones sometimes block bile flow out of the gall bladder, causing stretching of the organ and pain. Inflammation of the gall bladder, known as cholecystitis, may also cause pain in this area.

Liver: It has a capsule with many nerve endings located along the surface. Conditions that stretch the liver capsule often trigger pain. Liver inflammation, or hepatitis, can develop from numerous causes. Viruses, abnormal fat accumulation in liver cells and excessive alcohol consumption commonly cause liver inflammation and pain. Pockets of infection, called abscesses, can also enlarge and stretch the liver capsule. In some cases, infection from the female reproductive organs spreads to the liver capsule, causing pain.

Large Intestine (Colon): Though a less common cause, inflammation of the colon — known as colitis — can trigger pain. This may be a result of infection or an inflammatory bowel disease, like Crohn disease. Diverticulitis is a type of colitis that occurs in weak areas of the colon known as diverticula. It is more common in the left lower quadrant but can occur in other areas of the bowel. Irritable bowel syndrome may cause generalised or local abdominal pain.

Lungs or Pleura: Although the lungs are not in the abdomen, nerve endings may cause direct pain into this region, a phenomenon known as referred pain. Pneumonia in the lower lobe of the right lung, in particular, can result in local pain. Other pulmonary conditions that lead to inflammation of the lining around the lungs, called pleurisy, may trigger abdominal pain. Pleurisy is often caused by viral infections but could also be the result of pulmonary embolism, where a blood clot goes into the lungs.

Kidney: Diseases that cause inflammation of the right kidney may lead to upper right abdomen pain. Kidney and urinary tract infections can be associated with abdominal pain, back pain, and burning with urination. Kidney stones can irritate the urinary tract or block urine flow from the kidneys. This blockage may cause the kidneys to become inflamed and enlarged, triggering pain. Cysts on the kidneys can also cause discomfort by stretching the tissue over the kidneys.

Pancreas: It is located in the upper middle abdomen, but may cause upper right abdomen pain via referred pain. Pancreatic inflammation may occur when gallstones block ducts leading to the pancreas or with alcohol abuse, potentially causing pain.

I do have a gut feeling that it could be a pleural or pancreas issue since you do seem to have performed the ultrasound by stating your fatty liver condition. But do consult a general physician who would accordingly handle your condition or refer you to the appropriate specialist upon confirming a diagnosis after performing some of the above stated investigations.

The doctors on THT Medical Board are

•    Dr Sanduk Ruit Medical Director, Tilganga Eye Hospital

•    Dr Bhagwan Koirala Cardiac Surgeon,TUTH

•    Prof Upendra Devkota Chief of Neurosurgery, National Institute of Neurological and Allied Sciences

•    Dr Kundu Yangzom Chief of OBGYN Services, Patan Hospital

•    Dr Kishore PandeyPediatrician, CIWEC

•    Dr Sameer AryalDentist, Advanced Dental Care

•    prof Dr Dwarika P Shrestha Head of Dermatology Department, Teaching Hospital and Consultant, Dermato-Venereologist, B&B    Hospital

•    Dr Ranjeet s BaralConsultant cardiologist, GP and Aeromedical Examiner at Ganga Lal, VAYODHA, Advanced Polyclinic and Norvic Hospital

•    Dr Prativa Shrestha Das is a Consultant Dermatologist and Aesthetician at Vayodha Hosptial, Balkhu

•    Dr Dilip Das is a Dentist at Vayodha Hospital, Balkhu

•    Dr Bharat Rawat is Consultant Cardiologist and Head of Cardiology Department at Norvic International Hospital Katmandu, Tripureshwor

•    Dr Uttam Kumar Sharma, is Associate Professor of Urology at TU Teaching Hospital and Urologist and Kidney Transplant Surgeon at Chirayu Hospital and Medical Institute, Basundhara, Kathmandu